POSITION SUMMARY:
The Physician Practice Coder position is responsible for accurate and compliant coding of surgical cases for multiple specialties across all care settings. This position directly impacts revenue integrity by ensuring optimal CPT / ICD-10-CM / HCPCS II coding and appropriate modifier s, along with minimizing payer front end rejections and denials. The Physician Practice Coder is a resource for the physicians and other health care providers in regard to coding and to review medical documentation to insure appropriate physician coding and billing.
Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers.
Position: Coder- Surgical
Department: BUMG Corporate PBO General
Schedule: Full Time
ESSENTIAL RESPONSIBILITIES / DUTIES:
· Perform coding and related duties of moderate and high complexity surgical cases, and Evaluation and Management services, using established guidelines in an accurate and timely manner.
· Review medical documentation and system generated charges or paper encounter forms. Appropriately assign CPT, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements .
· Research billing rules and regulations for new and existing procedures .
· Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct and report potential coding problems.
· Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, workshops, review of current literature and other educational programs.
· Resolves coding edits and denials in a timely manner. Identify opportunities to reduce denials and enhance revenue.
· Provide cross coverage of multiple specialties .
· Function as a resource to external customers. Research and resolve coding questions/ inquiries. Make recommendations for coding policy changes.
· Functions as subject matter expert for assigned specialties .
· Develop and maintain division specific coding procedures and/or billing area instructions .
· Complete special projects and other duties as assigned by manager.
· Participate in coding education for providers and co-workers upon request.
· Maintain coding certification.
· Sequence diagnoses, procedures and modifiers by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
· Maintains productivity standards set forth in Departmental Policies and procedures.
· Ensure billed service is being accurately coded.
· Must adhere to all of BMC’s RESPECT behavioral standards.
· Ability to work in face-paced, results driven position
JOB REQUIREMENTS
EDUCATION:
· Associates Degree (or direct work experience equivalent to at least 3 years).
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED :
· Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, COC-A, CANPC, CGSC, CIC, CCA, CPC-A, CCS, CCS-P, RHIT, or RHIA
EXPERIENCE:
· Minimum of 3 years’ experience conducting surgical coding/auditing in a surgical e nvironment to include compliance, and billing processes.
KNOWLEDGE AND SKILLS:
· Advanced Proficiency in ICD-10, CPT, HCPCS, and modifiers for coding of professional fee services.
· Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
· Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
· Able to correctly code moderate/high complexity work.
· Understands, retains, and is able to research coding billing rules,…